PQRS & Value-Based Payment

Resources from SHM

The Centers for Medicare and Medicaid Services (CMS) is pursuing a pay-for-performance agenda for physicians that aligns quality measures from the Physician Quality Reporting System (PQRS) with cost and efficiency measures to create the Value-Based Payment Modifier (VBPM). PQRS is a pay-for-reporting program, where successful reporting of quality measures will prevent the penalty. The VBPM is a pay-for-performance program, using PQRS quality measures and CMS-calculated cost measures to create a positive or negative payment adjustment based on performance. Together, these programs are designed to begin reimbursing for the value, not simply quantity, of services provided through Medicare.

Penalties

Although CMS has aligned reporting in the programs, PQRS and the VBPM both have separate penalties because they were created separately. Providers who do not successfully meet the reporting requirements for PQRS will be assigned the full PQRS and value-based payment modifier penalties.

Legislative Background

The Tax Relief and Health Care Act of 2006 created the Physician Quality Reporting System, with subsequent continuations in the Medicare, Medicaid, and SCHIP Extension Act of 2007, the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 and the Affordable Care Act (ACA) of 2010. MIPPA granted permanency to the program; the ACA extended PQRS incentive payments to 2014 and established penalties for 2015.

The VBPM, introduced under Section 131 of the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 and expanded under Section 3003 of the Affordable Care Act, is continuing to grow and change, making the sustained advocacy efforts of SHM critical. By 2017, the VBPM is required to be applied to all physicians. In April 2015, Congress passed the Medicare Access and Chip Reauthorization Act (MACRA), which ends the PQRS and VBPM penalties in 2019 and institutes a new pay-for-performance program, the Merit-Based Incentive Payment System (MIPS).

What Can You Do?

Make sure you are participating in PQRS. Check whether or not you are reporting on quality measures to avoid the yearly penalties.

Stay informed. PQRS and the VBPM is updated and refined each year through the federal rulemaking process.

Share experiences. Input shared will help inform the SHM’s position and frame its comments provided to CMS. Join discussions around quality reporting and the VBPM in the Advocacy and Public Policy Community of SHM’s Hospital Medicine Exchange (HMX).

What is the Society of Hospital Medicine (SHM) Doing?

Providing feedback to CMS as part of the normal rulemaking process for the Physician Fee Schedule.

SHM’s Performance Measurement and Reporting Committee (PMRC) is dedicated to engaging quality measurement and working to ensure measures make sense for hospitalist quality improvement.

Report Measures Via the PQRS Wizard Registry

SHM has secured a significant discount for SHM members to report PQRS through the PQRSwizard. It is a fast, convenient and cost-effective online tool to help collect and report quality measure data to CMS.

The PQRSwizard is powered by the CECity Registry®, a CMS-qualified registry for PQRS reporting.